Laser Doppler flowmeter study on regional cerebral blood flow in early stage after standard superficial temporal artery-middle cerebral artery bypass surgery for moyamoya disease
- Author:
- No author available
- Journal Title:
- CHINESE MEDICAL JOURNAL
- Issue:
- 20
- DOI:
- 10.3760/cma.j.issn.0366-6999.2009.20.003
- Key Word:
- moyamoya disease;STA-MCA bypass;laser-Doppler flowmetry;regional cerebral blood flow
Abstract： Background Standard superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery is an effective treatment for moyamoya disease, but recent evidence suggests that postoperative cerebral hyperperfusion can occur. In this study, the trendline of changes in regional cerebral blood flow (rCBF) after surgery were continually monitored near the site of anastomosis in order to investigate both the efficacy of the procedure for improving rCBF and the possible riskof hyperperfusion.Methods Standard STA-MCA bypass surgery was performed on 13 patients, rCBF was measured continually using laser Doppler flowmetry (LDF) until the 5th day after the operation with the LDF probe implanted adjacent to the area of the anastomosis. The trendline of rCBF changes postoperatively was recorded for the analysis performed using SPSS 13.0.Results The baseline LDF value of cortical rCBF was (84.68±14.39) perfusion unit (PU), which was linear relative to absolute perfusion volume before anastomosis and (88.90±11.26) PU immediately after anastomosis (P >0.05). The value changed significantly from before to after anastomosis (P <0.05); it was (417.72±21.35) PU on the 1st day after surgery, and (358.99±18.01) PU, (323.46±17.38) PU, (261.60±16.38) PU and (375.72±18.45) PU on the following 4 days,respectively. The rCBF decreased gradually from the 2nd day until the 4th postoperative day, but still was at a high level (P<0.05). However, on the 5th postoperative day the rCBF increased again to the second highest level, which was significantly different compared with the baseline value (P<0.05), but not significantly different compared with the values on the other 4 days (P>0.05).Conclusions STA-MCA anastomosis improves the cerebral blood supply significantly in the early stage after surgery,however, the risk of symptomatic hyperperfusion may exist, which may possibly occur on the 1st day and 5th day after surgery. A LDF is useful for postoperative monitoring for both the efficacy of bypass and possible risk of neurologic deterioration or bleeding from hyperperfusion.
- [1]曹合利,田恒力,胡锦,等.经颅多普勒超声评价神经外科麻醉对脑血流动力学的影响[J].2007,(16).
- [2]Kawaguchi T,Minoshima S,Ishii K,etc.Prediction of hyperperfusion after carotid endarterectomy by brain SPECT analysis with semiquantitative statistical mapping method.[J].2003,34(5).
- [3]K, Houkin,T, Ishikawa,T, Yoshimoto,etc.Direct and indirect revascularization for moyamoya disease surgical techniques and peri-operative complications.[J].1997,99 Suppl 2.
- [4]R C, Heros,R M, Scott,J P, Kistler,etc.Temporary neurological deterioration after extracranial-intracranial bypass.[J].1984,15.
- [5]Schregel, W.,Bredenkoetter, U.,Sihle-Wissel, M.,etc.Transcranial Doppler Sonography: Effects of Intravenous Anaesthetic Agents in Neurosurgical Patients[J].1995,16(2).
- [6]R F, Spetzler,C B, Wilson,P, Weinstein,etc.Normal perfusion pressure breakthrough theory.[J].1978,25.
- [7]T M, Sundt,F W, Sharbrough,D G, Piepgras,etc.Correlation of cerebral blood flow and electroencephalographic changes during carotid endarterectomy: with results of surgery and hemodynamics of cerebral ischemia.[J].1981,56.
- [8]Yamane K,Okada Y,Shima T,etc.Effectiveness of superficial temporal artery-middle cerebral artery anastomosis in adult moyamoya disease: cerebral hemodynamics and clinical course in ischemic and hemorrhagic varieties.[J].1998,29(3).
- [9]Walther N KAvan Mook,Roger J M W Rennenberg,Geert Willem Schurink,etc.Cerebral hyperperfusion syndrome[J].2005,4(12).
- [10]R A, Solomon,C M, Loftus,D O, Quest,etc.Incidence and etiology of intracerebral hemorrhage following carotid endarterectomy.[J].1986,64.
- [11]D G, Piepgras,M K, Morgan,T M, Sundt,etc.Intracerebral hemorrhage after carotid endarterectomy.[J].1988,68.
- [12]Ogawa A,Saitoh H,Ogasawara K,etc.Cerebral hyperperfusion after carotid endarterectomy is associated with preoperative hemodynamic impairment and intraoperative cerebral ischemia.[J].2006,26(7).
- [13]Suzuki Jiro.Cerebrovascular\"Moyamoya\" Disease[J].1969.
- [14]B F, Matta,A M, Lam.Nitrous oxide increases cerebral blood flow velocity during pharmacologically induced EEG silence in humans.[J].1995,7(2).
- [15]Fujimura M,Kaneta T,Mugikura S,etc.Temporary neurologic deterioration due to cerebral hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in patients with adult-onset moyamoya disease.[J].2007,67(3).
- [16]Y, Kuroda,M, Murakami,J, Tsuruta,etc.Blood flow velocity of middle cerebral artery during prolonged anesthesia with halothane, isoflurane, and sevoflurane in humans.[J].1997,87.
- [17]Ogawa A.Pretreatment with the Free Radical Scavenger Edaravone Prevents Cerebral Hyperperfusion after Carotid Endarterectomy.[J].2004,55(5).
- [18]Mugikura S,Shimizu H,Tominaga T,etc.Incidence and risk factors for symptomatic cerebral hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in patients with moyamoya disease.[J].2009,71(4).
- [19]Kaneta T,Tominaga T,Fujimura M.Efficacy of superficial temporal artery-middle cerebral artery anastomosis with routine postoperative cerebral blood flow measurement during the acute stage in childhood moyamoya disease.[J].2008,24(7).
- [20]Reizo Shirane,Yasuko Yoshida,Toshie Takahashi,etc.Assessment of encephalo-galeo-myo-synangiosis with dural pedicle insertion in childhood Moyamoya disease: characteristics of cerebral blood flow and oxygen metabolism[J].1997,99(1).